Technological solutions such as computerized provider order entry (CPOE) hold promise for reducing medication errors at the prescribing and dispensing stage, but patients may still be harmed by incorrect administration of medications, which have been shown to be disturbingly common in prior studies. Conducted at an academic hospital in Spain that had an established CPOE system, this study found an overall administration error rate of 22%, consistent with prior studies. The hospital in question did not have a barcoding medication administration system. Combining barcoding with CPOE in a closed-loop system has been shown to significantly reduce the overall medication error rate.

This pre–post study examined the effect of team training on an emergency response team's performance in a perinatal emergency simulation. Following the training, performance in the simulation identified more latent safety threats and adherence to a safety checklist increased. The authors suggest that team training can enhance maternal safety.

This cluster-randomized trial examined whether a team training intervention would improve perinatal and maternal outcomes for singleton births without congenital abnormalities, on or after 32 weeks gestation. Researchers found no significant change in incidence of adverse outcomes, suggesting that simulation-based training alone is not sufficient to optimize perinatal safety.

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Failure to speak up and raise concerns in the clinical environment can adversely impact patient safety. In this randomized controlled trial, simulation-based education provided to postpartum and labor and delivery nurses in the intervention arm was not associated with a difference in speaking-up scores as compared to those in the control group overall.

High nurse workload has been linked to worse patient outcomes and increased burnout. In this multicenter, randomized trial involving nurses from eight intensive care units in France, researchers exposed the intervention group to a course that included simulated clinical scenarios and debriefing exercises. The simulated scenarios covered both clinical knowledge topics as well as teamwork training principles. At 6 months, they found that reported job strain was less prevalent in the intervention group. Although the study did not directly measure burnout, the results demonstrate that well-designed, targeted interventions can address factors known to result in psychological harm in the work environment.

This pre–post study of errors in anesthesia compared self-reported errors before and after implementation of a medication safety bundle that included smart infusion devices and barcode medication administration. Wrong-medication errors declined after barcoding was introduced, consistent with prior studies.

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Inadequate nurse staffing in hospitals leads to increased morbidity and mortality. Two proposed explanations are that nurses provide surveillance and reassessment, which are particularly important for seriously ill patients, and that inadequate staffing leads to missed nursing care. This retrospective cohort study assessed the impact of a 2016 Massachusetts law that mandated minimum nursing ratios in intensive care units. Mortality and complication rates did not change after the law's passage, nor did they differ from states without staffing ratio mandates. Nurse staffing was not substantially higher in Massachusetts after the mandate when compared with other states. Two accompanying editorials highlight the challenges of measuring and promoting appropriate nursing care, which authors argue cannot be simply defined with a staffing ratio. A PSNet perspective and a WebM&M commentary further explore the safety risks of missed nursing care.

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Although this survey of perioperative nurses, technologists, and unlicensed staff in two academic medical centers found disruptive behavior to be common, staff did not perceive any impact on patient safety, contrary to evidence. An AHRQ WebM&M commentary discussed how a physician reacted negatively after a nurse spoke up about his unsafe practice.

Emergency department (ED) nurses and physicians who had previously undergone teamwork training had a more positive perception of their overall job environment compared with staff in a similar ED who had not participated in teamwork training.

This study used serial surveys over a 1-year period to assess changes in physician and nurse satisfaction with a new computerized provider order entry system. Though nurses expressed considerable dissatisfaction initially, their satisfaction improved over time, whereas physicians were only moderately satisfied with the system both initially and after gaining more experience.

The commonly used expression "missing the forest for the trees" is a shorthand summary of the concept of situational awareness—the degree to which a clinician's perception matches reality. Situational awareness requires that clinicians can perceive the information they need, comprehend the importance of this information, and forecast the implications of this information (i.e., adverse consequences that might happen). Nurses' role in patient safety is largely dependent on maintaining situational awareness, and this study used direct observation of intensive care unit (ICU) nurses in three hospitals to assess the degree to which monitoring devices and other information displays supported each phase of situational awareness. The authors found that the design of bedside information displays often impaired nurses' ability to gather critical patient data, particularly around medications, resulting in the potential to harm situational awareness. The authors make recommendations, based on human factors engineering principles, to improve the quality of information displays in the ICU.

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This survey of intensive care unit nurses revealed many barriers to reporting medication errors, and nurses reporting higher levels of burnout had more strongly negative opinions of the utility of error reporting.

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Medication administration errors are a common problem and have been linked to interruptions during nursing workflow. This study used behavioral psychology techniques to analyze how nurses' bedside behaviors influenced their ability to prevent medication administration errors.

By enhancing providers' ability to transmit information in a concise and standardized fashion, electronic medical records (EMR) offer great promise for improving handoffs and signouts. However, this analysis of nursing handoffs at an institution with a commercial EMR found that the built-in patient summaries provided inadequate detail and flexibility for clinical signout purposes, forcing nurses to develop workarounds for transmitting key information. This finding reveals the importance of human factors engineering in designing information technology solutions for patient safety problems.

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This study found that ICU nurses were more accepting of electronic health records (EHR) at 12 months after implementation compared to 3, and this acceptance was predicted by EHR usability and computerized provider order entry usefulness.